Patients from Nagaland often travel to Assam for medical attention. Meghalaya has set up permanent accommodation in Vellore, Tamil Nadu, for patients travelling there for treatment. A severe shortage of medical personnel and facilities is the major problem in the northeast
* When TW, a teacher in the northern district of Mon in Nagaland, needed treatment for an infected leg she painfully made the trip from her village to the district headquarters, and from there bore a seven-hour bus ride over a road that's a little better than a bullock-cart track to the town of Sonari in Assam. Like many who need medical attention and care in the remote district, she has no confidence in the government hospital and would rather undergo the hardship of travelling to the next state in order to be treated.
* VA, a senior member of a village council in Nagaland's Kohima district, was left with little option but to travel first to Dimapur, and then to Guwahati, to seek treatment for a kidney ailment. Although the state capital Kohima is a little over an hour away by road from his village, VA's condition could be diagnosed only outside the state. Through 2004, at great cost to his family, he has had to be treated far away from his home village.
* Two years ago PS, who runs a small grocery shop in Shillong, Meghalaya, was advised a CT scan of the head. She was told this could be done only at a private hospital in Guwahati, which is three-and-a-half hours by road. The scan cost her about Rs 1,500 and she was able to pay for it only by borrowing money from friends and family. Yet she counts herself more fortunate than other people she knows who have been forced to sell their assets to pay for medical diagnosis and treatment.
The major problems of the health sector in the northeast are severe shortages of personnel and facilities. The northeastern states have a combined population of around 39 million (about 3.7% of the country's total population). In Arunachal Pradesh, Manipur, Meghalaya, Mizoram and Nagaland, scheduled tribes comprise about two-thirds of the population. The number of indigenous communities in this patchwork of states is probably as great as the number of dialects, but it is generally reckoned that there are over 200.
Examples such as those cited above help explain why the Nagaland state government has been running up a bill of around Rs 20 crore a year as reimbursements for those from the state who are forced to seek medical treatment outside it. "The lack of adequate specialty services means people have to go outside the state to seek healthcare. Laboratories and other associated ancillary diagnostic facilities are at a premium -- few and outdated. There is only one CT scan machine in the whole state, at a private hospital in Kohima. Patients requiring high-end investigations and immunology are sent to Mumbai, Kolkata and Guwahati," says the Nagaland State Human Development Report 2004, the state's first.
In Meghalaya, the dependence on external medical diagnosis and healthcare is even more pronounced. Late in 2004, the Meghalaya state government announced, with some fanfare, the inauguration of a 'Meghalaya House' in Vellore , Tamil Nadu, to "provide accommodation to Meghalaya people going for treatment at the Christian Medical College " there. Reportedly, the state government has so far paid Rs 6,500,000 to the Tamil Nadu Housing Board for the 10 houses purchased solely to accommodate those from the state who travel to Vellore -- this is a high-traffic route -- seeking medical diagnosis and healthcare.
The wrangling between the state governments of Meghalaya and Assam and the central government over the planned "super-specialty" hospital -- the North East Indira Gandhi Regional Institute for Medical Sciences (NEIGRIMS) -- has not helped. The institute was originally approved by the central government in May 1986 and would have then cost Rs 72 crore if completed on schedule in March 1999. In February 2001 the project was re-opened with a new deadline of March 2005 and a project cost of Rs 422 crore. The 500-bed NEIGRIMS is now being monitored by the ministry of statistics and programme implementation and is expected to be completed in May 2005.
While the government in Shillong is understandably upbeat about the regional institute being set up there, Assam's government has been voluble in its disappointment at the Guwahati Medical College not yet being "upgraded" to the status of an All India Institute of Medical Science, and has tended to view the nascent institute in Shillong as having diverted much-needed funds and central attention away from the state.
Although the condition of health infrastructure in the northeast region ranges from basic to abysmal -- the Guwahati Medical College does not have a fully equipped emergency ward -- such one-upmanship does little to provide desperately needed regional solutions. If the college at Guwahati needs to be upgraded, a popular argument in Assam points out, what about the Assam Medical College in Dibrugarh, which at one time was reputed to be the premier medical education institution and hospital in the entire region? Students at the Dibrugarh college have been led to agitate at the lack of facilities in their institute, which has the potential of attending to the healthcare needs of Arunachal Pradesh, the northern districts of Nagaland, and of course the upper Assam region -- the tea and oil belt of the northeast.
Yet Assam 's own Human Development Report of 2003 had cautioned: "People do not necessarily visit the facilities, even if they are available. While this may be due to a variety of reasons -- credibility loss, poor care and attention, amount of time taken, absence of medicines and sometimes absence of doctors -- it has important policy implications." It is indeed the absence of enough doctors and trained medical personnel that drags down health indicators all across the region.
Nagaland has less than 500 doctors, including 98 specialists, to serve a population of 2 million. The indications are that Naga students want to enter medicine, but with no institute for medical education in the state Nagaland exports a human resource it simply cannot afford to. Meghalaya is short of at least 100 doctors, which the state government has said "severely affects" healthcare in rural areas of the state, with most primary health centres and community health centres insufficiently staffed, complained state Health Minister Sayeedullah Nongrum. Manipur's Health and Family Welfare Minister Laishram Nandakumar has pointed out in the state assembly that the state is short of around 160 doctors (including 120 specialists) and that there are only 150 doctors in the state health department who are very thinly deployed over 420 public health sub-centres, 72 public health centres and 16 community health centres.
There are a host of plans and initiatives aimed at improving health services in the northeast. The region's nodal development agency, the North Eastern Council, is supporting a tele-medicine network for the northeast in association with the Indian Space Research Organisation. Tele-medicine facilities are planned for all the medical colleges in the region: the Guwahati Medical College and Hospital, Silchar Medical College , Assam Medical College and the Regional Institute of Medical Sciences in Imphal. Simultaneously, a North East Health Care Mission is likely to be launched this year, with an act establishing the mission to be brought before parliament soon. Under this, Rs 88 crore a year will be used to take healthcare to every village.
Finally, a region-wide health insurance programme is being promoted. Without the healthcare basics being addressed, however, and urgently, such programmes are only likely to widen the disparities within medical care in the region.
InfoChange News & Features, June 2005